Journal of Medicine and Medical Sciences Vol. 3(5) pp. 355-364, May 2012
Available online@ http://www.interesjournals.org/JMMS
Copyright © 2012 International Research Journals
Full Length Research Paper
The Model Development of Participatory Education on Adolescent
Reproductive Life (PEARL) Programme to prevent Unintended
Pregnancy among Myanmar Migrant Adolescent and Youth in Samut
Sakorn Province, THAILAND: (Intermediate outcome and impact
analysis)
Kyaw Min1 MBBS, MCTM, Ph.D PH, FRSTMH, *Kanittha Charmroonsawasdi2 Ph.D,
Surasak Taneepanichskul3 MD., MSc, FRCOGT, Ratana Somrongthong4 Ph.D,
Damrong Reinprayoon5 MD., MPH, Dusit Sujirarat6 MSc, Nawakamon Suriyan7 DDS, PGDip OMFS, Ph.D PH
1
Assoc. Prof. & Clinical Coordinator. Faculty of Medicine, AIMST University, Bedong, Kedah State, Malaysia
2
Assist. Prof. & HOD. Department of Family Health, Mahidol University, Bangkok, Thailand
3
Prof. & Dean. College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
4
Assist. Prof. & Deputy Dean. College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
5
Prof. & Director of Red Cross Volunteers Bereau, Thai Red Cross Society, Bangkok, Thailand
6
Assoc. Prof. Department of Epidemiology, Mahidol University, Bangkok, Thailand
7
Dental Implantologist, Prachatipat Hospital, Pathumthani, Thailand
*Corresponding author email: phknt@mahidol.ac.th
ABSTRACT
There are increasing abortion rate among Myanmar migrants in Samut Sakorn Province, Thailand. The objective
of the study was to develop a participatory education on adolescent reproductive life (PEARL) programme to
prevent unintended pregnancy among Myanmar migrant adolescent and youth in the Province. Population for
this study was Myanmar migrants both female and male, 15-24 years of age, both registered and unregistered
living in Samut Sakorn province. The study design was a research and development (Action Research), after
development of the model PEARL, implementation was done between the two intervention groups “PEARL”,
“Teaching only” group comparing with “Control group” there had no intervention. The effectiveness of this
program was assessed by pretest, post 1 month, post 3 months, and post 1 year during the period from 17 July
2010 to 22 September 2011. During the study period, there were 33 participants enrolled in each group. The study
results found that all general characteristics and pretest mean scores of most of the measured variables were not
significant difference among the three groups (p-value >.05). Comparison of the mean scores before and after 1
year intervention, all of the knowledge variables (Knowledge on puberty KOP, Knowledge on adolescent and
youth pregnancy KOAYP, knowledge on pregnancy prevention KOPP, and knowledge on induced abortion KOIA)
were significantly improved in “PEARL” group, whereas, KOP, KOAYP, and KOPP were also improved in
“Teaching only” group (p-value <.001) but no change in “Control” group (p-value > .05). On the other hand,
significant improvement of attitude towards unintended pregnancy prevention and induced abortion were only
found in “PEARL” group (p-value <.001). Regarding intension to refuse sex and to use condom in the next 6
months, there had a significant improvement in “PEARL” group and “Teaching only” group (p-value <.001).
Pairwise comparison among groups for post 1 year assessment was found that “PEARL” group had significant
higher mean scores in 4 out of 4 knowledge variables (KOP, KOPP, and KOIA) (p-value < .05), attitude towards
unintended pregnancy prevention and induced abortion (p-value < .05), and intension to refuse sex and to use
condom in next 6 months (p-value < .001) than “Teaching only” group, whereas, all of the knowledge, attitude,
norm for safe sex and induced abortion, intension to refuse and to use condom in next 6 months were
significantly higher than “Control” group (p-value < .001). Only one unintended pregnancy was noted at post 1
year assessment in “Control” group. This revealed that participatory education on unintended pregnancy
prevention plus facilitation by peer volunteers (PEARL) had the best outcome improvement in knowledge,
attitude, and intension to prevent unintended pregnancy among Myanmar migrants in Samut Sakorn Province,
Thailand. There should be continuous action plan for sustainable achievement to prevent unintended pregnancy
among Myanmar migrants.
Keywords: Adolescent, Myanmar Migrants, Participatory Education, Unintended Pregnancy, Peer Volunteer
356 J. Med. Med. Sci.
INTRODUCTION
Adolescent, the period between childhood and adulthood
is a time of profound biological, social, and psychological
changes accompanied by increased interest in sex. This
interest places young people at risk of unintended
pregnancy, with consequences that present difficulties for
the individual, family, and community (DiCenso and Van
Dover, 1999).
Migrant workers from Myanmar come from a variety of
geographical locations and ethnic groups. There are both
push and pull factors at work when people make the
decision to migrate to Thailand. The pull factors include
the close geographical location of Thailand to Burma as
well as the demand in Thailand for cheap labor (Amnesty,
2002). In Samut Sakorn province, Registered Migrants
55,749 persons and estimated Non-registered Migrants
about 20,000-70,000 are living, of which 97% are
Myanmar. (WHO, “Border Health Program, 2006)
In one the baseline survey among the Myanmar
migrant in coastal provinces of Thailand (including Samut
Sakorn), they found that the age at first sexual
intercourse between the ages 15-19 years were 40.2%
(n=1384) in male and 44.5% (n=310) in female (PHAMIT,
2005). Regarding the peer influence both positive and
negative effect among adolescent and youth, the data
from a national probability sample of 15-19-year-old
women are analyzed to determine the influence of
parents and peers on the views of young women and
how this influence is related to premarital sexual
behavior, contraceptive use, and premarital pregnancy.
They concluded that women influenced by friends have
higher levels of premarital pregnancy than do those
influenced by parents (Shah and Zeinik, 1981).
Rational of the study was, in Samut Sakorn Province,
under 20 years old pregnancy rate is about 10.8% of total
pregnant Myanmar migrant women and there are 1,507
antenatal care cases, 1,517 delivery cases and 313
abortion cases among 7,000 migrant women in 2009
(Samut Sakorn Provincial Health Office Report, 20062009). Samut Sakorn is located 30 kilometers from
Bangkok. The province occupies a total area of 872
square kilometers and is administratively divided into 3
districts: Muang Samut Sakorn, Krathum Baen, and Ban
Phaeo.
The research question was “Have the facilitation by
PVs (Peer Volunteers) in PEARL (Participatory Education
on Adolescent Reproductive Life) programme on
unintended
pregnancy
prevention
education in
intervention group 1 better than only participatory
education program in group 2, to reduce adolescent and
youth unintended pregnancy among Myanmar migrants?”
The specific objective was to determine the effectiveness
of the PEARL programme to prevent unintended
pregnancy among Myanmar migrant adolescent and
youth in Samut Sakorn Province, Thailand, comparison
among “PEARL” group, “Teaching only” and “Control” no
intervention group.
MATERIAL AND METHODS
The study design was the research and development
(Action Research) which contained three phases as:
phase 1: Situational analysis by qualitative indebt
interview 2: Implementation of PEARL programme using
Quasi-experimental study, and phase 3: Programme
evaluation. Immediate outcome assessment was done
one month after post intervention, intermediate and
impact analysis was done 3 months and one year after
post intervention. This study was conducted in Muang
district, Kokrak and Krathum Baen district, Samut Sakorn
Province, Thailand. The study sites were Gold price
community, Kokrak community, and Krathum Baen
community; those are 15 kilometers far from each other.
The study population for this study was Myanmar
migrants both male and female, 15-24 years of age,
marriage or single, both registered and unregistered
living in Muang District, Samut Sakorn province, from 17
July 2010 to 22 September 2011.
The estimated sample size was calculated by
comparisons of two means formula, according to
standard statistical criteria (α =0.05, power of the test =
90%). Difference between means and standard deviation
of two groups was used from previous study in 2008,
intention to use condom before and after sex education (Thato et
al, 2008). The sample size calculated was 30 per each
group and we added another 10 percent for estimated
attrition.
Detail of sampling technique and procedures were: (1)
simple random sampling of three study sites were done
and PEARL was in Golden price community, “Teaching
only” was in Kokrak community, and Control was in
Krathum Baen community. (2) Announcement for
participation in the program through provincial health
office and criteria of participant was mentioned in
announcement. (Myanmar migrant Age between 15-24
years, Male or female; Registered or unregistered,
marriage or single, can constantly stay in Samut Sakorn
province during the study period, willing to participate in
the study, mentally healthy and can read and write
Myanmar language). Exclusion criteria for participant
were past history of attended in reproductive health
education training, withdrawn from the study with any
reasons, incomplete participation to the programme and
incomplete answers on the questionnaires. (3) One Peer
volunteer supervisor was selected by researcher and
provincial health office, according to selection criteria;
Min et al. 357
preferable Bachelor degree, Female or male, married or
single, willing to participate in the project, and work
experience at least two years working in Myanmar
migrant reproductive health project either provincial
health office or NGOs. One Myanmar migrant staff, he
has been working in Myanmar migrant health system
development office, Samut Sakorn provincial health office
for 5 years was recruited; graduated Bachelor of Nursing
from Thailand. Incentive was travel and other allowances
about 3000 bahts/month and certificate will be given by
joint venture with College of Public Health Science,
Chulalongkorn University and Provincial Health Office
upon satisfaction after the project. (4) Upon the number
of application in three sites of study, out of 40 to 42
participants from each group, those entitle the inclusion
criteria, 33 participants were selected by researcher and
peer volunteer supervisor by simple random sampling in
each three study groups. In the group with peer
volunteers, 36 participants were selected and along with
three peer volunteers were elected by their peer group
members according to inclusion criteria “at least high
school level education, age between 18 to 24 years,
Female or Male” i.e one out of twelve peer participants
(bottom up approach). Incentive of the three peer
volunteers was travel and other allowances probably
about 1000 bahts/month, free minor health care, and
certificate was given by joint venture with College of
Public Health Science, Chulalongkorn University and
Provincial Health Office upon satisfaction after the
project.
The roles and responsibility of peer volunteer
supervisor was serve as a supervisor
on 3 peer
volunteers for sharing information, providing advices if
they had some issue among their groups, monitoring the
monthly data management, and planning and discussion
on monthly small group counseling by case scenarios, as
a coordinator among researcher, provincial health office
and peer volunteers to clarify information and better
project management, and as a tutor during the lectures
given by researcher to peer volunteers and participants.
For the peer volunteers was serve as a facilitator within
the 11 adolescent participants for sharing information and
awareness raising by daily telephone counseling, monthly
small group counseling by case scenarios, as a facilitator
between researcher, peer volunteer supervisor and group
members to clarify information and better decision
making, as a tutor within the group during the lecture
given by researcher, and provide the special attention on
risk person within the group such as those married,
having boy friend-girl friend, and working at massage
room and sex worker. Provide frequent meeting with
them for increase awareness on safe sex and/or
abstinence.
The researcher was used “PEARL training manual
guide” that was developed by researcher according to
participatory learning (David A Kolb, 1991) and life skills
training (WHO, 1994) and some of them were applied
from other’s researches that have done on HIV
prevention intervention. After that the manual was
submitted to three experts to assess its contents validity.
Recommendations from the experts were collected and
used to revise and upgrade the study tool accordingly.
Moreover, the revise “PEARL training manual guide” was
translated into Myanmar language and was conducted
pilot study among 10 Myanmar migrants in Samut Sakorn
for appropriateness, sequential and smoothness to reach
the objectives. Finally, the manual was revised according
to weakness find in pilot study.
The “PEARL training manual guide” was containing 9
modules, 4-5 activities are included in each module, it
was taken 2 hours for each module, and 1 module/day
was taught. The module number 2 and 3 are only for 1
peer volunteer supervisor and 3 peer volunteers. After
selecting these four persons, researcher taught them all 9
modules. At the end of all activities and modules, there
have evaluation section by check list, questions and
answers.
Module 1: Introduction to PEARL training
Module 2: Identifying participants, Collecting,
Analyzing, and Using Monitoring Data, Developing a
Monitoring and Evaluation Work Plan
Module 3: Communication Skill and Problem Solving
Skill
Module 4: Puberty (Anatomical and Physiological
Changing of Human Reproductive Organs)
Module 5: Adolescent Pregnancy and Unintended
Pregnancy
Module 6: Sexually Transmitted Infection(s), HIV/AIDS
Module 7: Abstinent and Natural Family Planning
Methods
Module 8: Other Contraceptive Methods (Barrier,
Temporary, Permanent and Emergency pills)
Module 9: Visit to Provincial Hospital and ANC Clinic
The researcher used self-administered questionnaire
that was developed by researcher according to IMB
(Information Motivation Behavior Skill) model (Fisher,
W.A., & Fisher, J.D, 1998) and participatory learning by
review literatures. After that the questionnaire was
submitted to three experts assessed its contents validity.
Recommendations from the experts were collected and
upgrade the study measurement tool. The revised
questionnaire was used as the pre-tested among 30
adolescent (15-24 years) Myanmar migrants in Samut
Sakorn and tested reliability by Cronbach’s α, and if it is
less than 0.7, was revised the questionnaire again until ≥
0.700. Informed written consent was obtained from all
358 J. Med. Med. Sci.
participants. The Ethical Review Committee for research
involving human research subjects, Health Science
group, Chulalongkorn University, Thailand, had approved
and the study title number is 038.1/53.
After the data collection process, all data was edited
and verified before analysis. All data was entered into the
Epidata version 3.1 programs and analyzed in SPSS
Statistical software 17.0. To compare demography
among the groups (Test of group differences) were
analyzed by one-way ANOVA and Chi-square. To test
intervention effects (before-after test) within group by
Paired t-test. All the sum of scores was tested by normal
distribution by kolmogorov-smirnov test. To compare
intervention effects among groups was analyzed by oneway ANOVA and general linear model, repeated
measures. P-value was at 0.05. If there was difference
among groups, analyzed by post-hoc test to know exactly
between which groups and for equal variances Bonferoni
was used and in case of equal variance was not
assumed the Dunnett T3 and Kruskal Wallis Test was
used.
RESULTS
During 1 year of the study period, there were 32
participants enrolled in each group, one female from each
group went back to Myanmar. As for comparing groups’
difference of general characteristic among the three
groups, there were no statistical significant (p-value>
.05). Before the beginning of the intervention, sum of
scores of knowledge on puberty (KOP), knowledge on
pregnancy prevention (KOPP), knowledge on induced
abortion (KOIA), attitude towards unintended pregnancy
prevention (ATUPP), attitude towards induced abortion
(ATIA), Norm for unsafe sex and induced abortion
(NORM), intension to refuse sex in the next 6 months
(INTRS), and intension to use condom in the next 6
months (INTUC) among the three groups were not
significant different (p-value > .05). On the other hand,
knowledge on adolescent and youth pregnancy (KOAYP)
was significantly lower in “Teaching only” group than
“PEARL” group and “Control” group, p-value .043 and
.012, respectively.
Comparison of the mean scores before and after 1 year
intervention, categorized by KOP, KOAYP, KOPP, KOIA,
ATUPP, ATIA, NORM, INTRS, and INTUC within the
“PEARL” group, within the “Teaching” group, and within
the “Control group” was mentioned in table 1. It can be
clearly seen that all of the knowledge variables were
significantly improved in “PEARL” group and “Teaching
only” group (p-value <.001) but no change in “Control”
group (p-value > .05). On the other hand, significant
improvement of attitude towards unintended pregnancy
was only found in “PEARL” group (p-value <.001),
whereas, there was no significant improvement of attitude
towards induced abortion in all groups (p-value > .05).
Regarding intension to use condom in the next 6 months,
there had a significant improvement in “PEARL” group
and in “Teaching only” group (p-value <.001). For the
NORM for safe sex and induced abortion, there had not
only significant improvement in “PEARL” group and
“Teaching only” group (p-value= .013) but also in
“Control’ group (p-value= .023). All of all, most of the
variables (7 out of 9) were significantly improved in
“PEARL” group (Table 1).
Pairwise comparison among groups for Post 1 year
assessment was elicited in Table 2. It was found that
“PEARL” group had significant higher mean scores in 4
out of 4 knowledge variables (KOP, KOAYP, KOPP) (pvalue < .05), ATUPP Attitude towards Unintended
Pregnancy Prevention (Figure 1), ATIA Attitude towards
Induced Abortion (Figure 2), NORM on safe sex and
induced abortion, INTRS Intension to Refuse Sex in next
6 months, INTUC Intension to Use Condom in next 6
months than “Teaching only” group and control group
(Figure 3). Regarding comparison between “Teaching
only” group and “Control” group, there had significant
higher mean scores in KOP, KOPP, KOIA, ATUPP,
INTRS) in “Teaching only” group (P-value < .05).
Regarding pairwise comparisons of safe sex behavior,
sex experience, and impact analysis; comparison of
history of sexual intercourse in past 3 months if they had
sex partners, between pretest and post 1 year were
analyzed. Even thought, there was reduced only in
“PEARL” group, we did not find significant difference (pvalue > .05).
Comparison of scores between pretest and post 1 year
for consistent use of condom if they have sex partners
was only found that only increase in “PEARL” group and
there was no significant difference in all three groups.
Regarding “unintended pregnancy occurred in the past
3 months” at post 1 year assessment, there were 0, 1,
and 2 participants in “PEARL” group, “Teaching only”
group, and “Control group”, respectively. There was no
unintended pregnancy in “PEARL” group and one
participant in “Teaching only” group she was married
person and born the baby. On the other hand, in control
group, the girl friend of 16 year-old single male had
pregnant and they did not use condom consistently and
sometimes they used safe period without condom. They
aborted and said not ready to marry.
Min et al. 359
Table 1. Comparison of pretest and post 1 year intervention (Paired t-Test)
Variables
PEARL (n=33)
Mean ± SD
5.8788±2.5465a
KOP
Teaching only (n=33)
b
p-value
<.001
13.2121±3.0286
<.001
3.8182±0.6826
4.8182±0.8823
<.001
15.1212±2.8587
<.001
4.8182 ± 0.8823
ATUPP
a
<.001
78.1818 ± 15.3592
ATIA
17.2424 ± 3.1027a
.001
11.0303 ± 3.1867a
<.001
19.9899 ± 3.2629a
20.0000 ± 3.5016
6.8182 ± 1.4021a
INTUC
9.1212 ± 1.8330
a P
b
9.2424 ± 4.5417a
<.001
3.4242 ± 1.9690a
.214
.820
8.7813 ± 2.7560a
.913
3.8182 ± 0.9828a
.325
3.4849 ± 1.5436
a
65.6970 ± 8.2101
.184
16.6364 ± 3.6642a
10.9091 ± 2.6382a
21.1818 ± 5.9079a
7.3030 ± 2.2289a
a
62.8788 ± 6.9361
.727
61.7879 ± 14.4778
.864
16.4545 ± 3.3550a
.107
14.7879 ± 4.6486
.010
10.2727 ± 3.8019a
.002
13.0606 ± 3.8238
.004 ↓
17.2424 ± 4.4019
<.001
4.0606 ± 0.9663a
8.8750 ± 3.7994
12.7879 ± 3.3049
.000
7.0606 ± 2.8829a
p-valueb
.716
4.0001 ± 1.1456
16.8182 ± 4.2680
16.4242 ± 3.6403
INTRS
<.001
62.1515 ± 12.1787
21.1515 ± 4.4590
NORM
2.8182 ± 2.1426a
4.001 ± 1.6394
62.1818 ± 5.6261
Mean ± SD
7.3438 ± 2.7790
12.8485±2.6707
3.7879 ± 0.8929a
KOIA
6.6667 ± 2.5577a
p-value
.003
4.5455 ± 0.9385
10.3333±2.9012a
KOPP
Mean ± SD
8.5455 ± 2.6586
a
KOAYP
Control (n=33)
b
18.7879 ± 6.2087a
.272
16.7879 ± 8.0303
.001 ↓
5.5455 ± 1.6219
Pretest
Sig (2-tailed)
KOP knowledge on Puberty, KOAYP Knowledge on Adolescent and youth Pregnancy,
KOPP Knowledge on Pregnancy Prevention, KOIA Knowledge on Induced Abortion
ATUPP Attitude towards Unintended Pregnancy Prevention, ATIA Attitude towards Induced Abortion
NORM on safe sex and induced abortion, INTRS Intension to Refuse Sex in next 6 months
INTUC Intension to Use Condom in next 6 months
6.5455 ± 2.2092a
6.5151 ± 2.8518
.960
360 J. Med. Med. Sci.
Table 2. Pairwise comparisons among groups for 4 times measurements (P0, P1, P3, P12)
Groups
Teaching only
Control
Mean ±SD
Mean ±SD
p-value
Mean ±SD
p-valuea
KOP
11.591 ± 1.3959
9.030 ± 1.3959
<.001
7.047 ± 1.4132
<.001
KOAYP
4.576 ± 0.7008
3.985 ± 0.7008
3.811 ± 0.7008
<.001
KOPP
13.485 ± 1.5510
11.061 ± 1.5510
<.001
8.102 ± 1.5740
<.001
KOIA
4.553 ± 0.8330
4.061 ± 0.8330
.044
3.492 ± 0.8330
<.001
ATUPP
70.5378 ± 5.4401
65.3561 ± 5.4401
<.001
61.84848 ± 5.4401
<.001
ATIA
18.7273 ± 1.9244
16.7955 ± 1.9244
<.001
15.8030 ± 1.9244
<.001
NORM
13.9318 ± 1.5510
12.7046 ± 1.5510
.005
12.1591 ± 1.5510
<.001
INTRS
22.5379 ± 3.0733
19.3333 ± 3.0733
<.001
17.3864 ± 3.0733
<.001
INTUC
8.1364 ± 1.0685
6.4697 ± 1.0685
<.001
6.3939 ± 1.0685
<.001
PEARL
a
.003
Teaching only
KOP
<.001
KOAYP
.940
KOPP
<.001
KOIA
0.02
ATUPP
0.031
ATIA
NORM
INTRS
INTUC
a.
Adjusted for multiple comparisons: Bonferoni
General Linear Model, Repeated Measures
.117
.469
.035
1.000
Min et al. 361
Figure 1. Estimated Marginal Means of Attitude towards unintended pregnancy prevention
Figure 2. Estimated Marginal Means of Attitude towards induced abortion
362 J. Med. Med. Sci.
Figure 3. Estimated Marginal Means of intension to use condom in next 6 months
DISCUSSION
The format of the design is most appropriate for this
research among migrant adolescent and youth population
as most of them are away from their family. Since the trial
did have a “no sex education” control group, we can draw
conclusion about the effectiveness of peer-volunteer but
also about the participatory sex education. This was
different from RIPPLE trial in England, studied about the
effect of different approaches in schools, peer-led sex
and relationships education (intervention arm) with
convention teacher-led sex and relationships education
(control arm). (Stephesonl, 2008).
All sample groups satisfied the criteria, including peervolunteers and peer-volunteer supervisor. In addition, the
sample groups were similar since they have been
working in tin food industry, mostly in seafood industries
and some were in chicken industries. Furthermore, in the
current study, the three communities were 15 kilometers
far from each other and they did not know where the
other study sites were. So, it can be concluded that there
did not have contamination of information among the
three groups. The researcher used the participatory
teaching method, according to the experimental learning
process, which covered all 4 components of learning
experience, reflection and discussion, understanding and
conceptualization, and experiment and application (David
A Kolb et al, 1991).
Comparison of mean scores between pretest and posttest in “PEARL” group, nine out of nine variables
measured such as all of the knowledge variables, attitude
towards unintended pregnancy, perception for norm of
safe sex and induced abortion, and intension to used
condom in the next 6 months were significantly improved
than pretest. This revealed that facilitation, sharing
information, awareness raises by daily telephone
counseling and monthly small group discussion by case
scenarios that led by peer-volunteers and supervision by
peer-volunteers’ supervisor was a more potent method of
achieving desirable improvement of not only knowledge
but also effect on attitude towards prevention of
unintended pregnancy.
Whereas, in “Teaching only” group, only four out of
nine variables (KOP, KOPP, KOAYP, NORM) are
significantly improved than pretest (instead of six out of
nine variables measured such as all of the knowledge
variables, perception for norm of safe sex and induced
abortion, and intension to used condom in the next 6
months was significantly improved than pretest in post 1
month study). There had no change in attitude. This
revealed that participatory education only would not have
achievement in improving attitude for prevention from risk
factors related to unintended pregnancy and induced
abortion. On the other hand, in no intervention group,
there had no change in nearly all of the variables
measured.
Moreover, the research result revealed that after the
post 1 year intervention, the experimental group I
“PEARL” group had significantly improved 4 out of 4
knowledge variables, attitude towards Unintended
Pregnancy Prevention, ATIA attitude towards Induced
Abortion, NORM on safe sex and induced abortion,
Min et al. 363
INTRS intension to refuse sex in next 6 months, INTUC
intension to use condom in next 6 months than
experimental group II, “Teaching only”. This finding
agreed with (Department of Education and Skills, 2003)
peer-led sex education has been highlighted as a
promising approach. This can also be concluded that
participatory education on unintended pregnancy
prevention with continuous supervision by peer-volunteer
supervisor, and close facilitation and counseling by peer
volunteers among their subgroups may be necessary for
noticeable improvement of knowledge, attitude, and
intention to prevent unintended pregnancy among
adolescent and youth Myanmar migrants.
Regarding, comparison between “Teaching only” and
“Control group”, there had significant higher mean scores
in KOP, KOPP, KOIA, ATUPP, INTRS) in “Teaching only”
group than “Control group”. This can be concluded that
participatory education only had moderate beneficial
effect on improving knowledge than no intervention. This
is similar finding as the study done among Thai school
adolescents in Thailand (Thato et al, 2008).
Regarding impact analysis, safe sex behavior, consistence
use of condom and contraceptive practice in “PEARL”
group are better than “Teaching only” and “Control”
group. Moreover, Pregnancy rate and abortion rate are
reduce in “PEARL” group than “Teaching only” and
“Control” group. But we could not find significant
difference and it might be due to study period, only one
year after intervention.
From the research result, it may be concluded that the
“PEARL”, participatory education on adolescent
reproductive life programme that was provided to
Myanmar migrant adolescent and youth in Samut Sakhon
province, Thailand was effective, since it sustainably
improved knowledge, attitude, behaviors and intention to
prevent unintended pregnancy. Using the participatory
learning principle as an enhancing activity is also
appropriate for arranging learning activities for
participants since its content, process, and duration were
appropriate.
Virtually no experimental or observational literature
reliably answers questions about the effectiveness of
counseling by peer-voluntary to reduce rates of
unintended (unwanted, mistimed) pregnancies in the
Myanmar migrants in Thailand. The term ‘‘peer’’ refers to
people of equal status can facilitate and sharing of
(sexual health) information, values and behaviors among
members of similar age or status group.
Instead of a one-shot approach, the use of regular
overtime appropriate programs is needed to reinforce
prevention efforts and to promote postponement of
sexual activity among adolescents, and to thus decrease
the risk of adolescent pregnancy.
Primary
care
nurses can design and implement intervention
programmes as a peer-volunteer supervisor that is
ongoing to influence and reinforce behavioural changes
to decrease unintended pregnancy.
For activities into different level approach, as there
have still pitfalls i.e lack of some items of knowledge not
only in “Teaching only” group but also in “PEARL” group
and did not improve most of items concerning attitude
towards unintended pregnancy prevention and induced
abortion in “Teaching only” group, we would like to
increase their awareness by PEERS, may classify into 3
levels as;
(1) Individual level: Myanmar migrant workers should
be empowered in terms of increase knowledge,
awareness rising on safe sex behavior, unintended
pregnancy prevention, and induced abortion by
participatory education plus trained peers facilitation not
only in their community but also in their work-site.
(2) Communities and group level: we need to
empower peer-volunteers and health personals as BCC
(behavior change communication); to understand and
consider the following points such as vulnerability and
risk factor of the target group, the conflict and obstacles
in the way to desire change in behavior, and type of
message and communication media which can best
reached to target group and type of resources available.
(3) Responsible organization level: The local
government such as Provincial Health Office and nongovernmental organizations have to plan a suitable BCC
specific for the migrant target, empowering the peer
volunteer supervisors and peer-volunteers or peereducators by the collaboration with educational
institutions as the “Triangle mountain model”,
simultaneous policy, academic and social movements.
In future research, selection of sample should be
stratified some variables such as marital status. All of all,
it could be concluded that, the community that effectively
prevents teenage pregnancy is one that consistently and
persistently promotes shared informations and values,
advocates restraint, and empowers peer-volunteers to
communicate with peers.
ACKNOWLEDGEMENT
First of all, we would like to thank “THE 90th
ANNIVERSARY OF CHULALONGKORN UNIVERSITY
FUND” (Rachadaphiseksomphot Endowment Fund) for
giving the research grant. Then, we would like to thank to
all participants, peer volunteer supervisor, and all peer
volunteers. Furthermore, we would like to express our
appreciation to College of Public Health Sciences,
Chulalongkorn University and Provincial Health office,
Samut Sakorn Province for giving permission to conduct
this intervention research. Furthermore, we extend our
sincere thank to Rat Thai NGO (Samut Sakorn Province),
Golden Price sea food factory, Dr. Nilar Han, and Ms.
Vatcharaporn Yaemyeesuin (Public Health nurse) for
helping us during the intervention and data collection.
364 J. Med. Med. Sci.
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